Provider Demographics
NPI:1194613091
Name:VANDER DOES, VICTORIAHNA ELIZABETH
Entity type:Individual
Prefix:
First Name:VICTORIAHNA
Middle Name:ELIZABETH
Last Name:VANDER DOES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 BELAUTO CT APT M
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1775
Mailing Address - Country:US
Mailing Address - Phone:716-348-1495
Mailing Address - Fax:
Practice Address - Street 1:735 BELAUTO CT APT M
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45430-1775
Practice Address - Country:US
Practice Address - Phone:716-348-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2507098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health